I understand that my data will be strictly confidential. This clinic does not sell, share, or resell information. I confirm that all information in this form is true and accurate. I confirm that if I hold some important information and complications happened, the clinic will not be liable. I release this clinic and hold harmless against any claims, expenses, damages, and liabilities.
I understand and acknowledge that there are risks involved with the treatment I will be receiving. Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications, and I have had the opportunity to ask questions regarding these risks and other possible complications.
I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, diet, and lifestyle and that there is a
possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost.
I understand that response of treatment varies on an individual basis and specific results are NOT guaranteed. Therefore, in consideration for any treatment/procedure/service received, I agree to unconditionally defend and hold harmless and release Esthetics by Monica Pessotti and the individual that provided my treatment from all liability, for any condition or result, known or unknown, that may arise as consequences of any treatment, procedure, & services that I received.